Integrated Neurology Healthcare

In 2013, to help develop their work plan, the Thames Valley Mental Health, Dementia and Neurology Network (MHDN) commissioned the Neurological Commissioning Support (NCS) to assess the state of play of neurology in the Thames Valley and identify any gaps and variances in service provision.

Key Messages

The makeup of neurological services across the Thames Valley SCN is complex. Historically there has been little local leadership for long-term neurological conditions (LTNC) across all health economies, this has led to a lack of designated leads, formalised integrated pathways and informed neurology commissioning. Services have evolved over time, driven by clinicians with individual interests in specific conditions; the result of developing and providing services in this way renders an overall vulnerability and service delivery tends to rest on individuals.

Some facts and figures:

The cost of providing non-elective/emergency admissions with a primary or secondary diagnosis equated to over £22 million in 2012/13.

An average clinical commissioning group (CCG) has a population of 225,000, and will have approximately 42,000 (18.7%) people living with a neurological condition such as multiple sclerosis (MS), Parkinson’s, Motor Neurone Disease (MND) or epilepsy and a further 33,500 (15%) living with migraine.

neurological symptoms account for about one in 10 GP consultations

6-1.0% of the population are diagnosed with a neurological condition every year

one in six people has a neurological condition which makes a significant impact on their lives

2% of the UK population is disabled by a neurological condition.

Current spending on neurological health and social care services, was estimated at £5.3 billion in 2009-10

New ways of working:

Based on the evidence provided by the NCS report and illustrated by the various reports and work undertaken on headaches, the MHDN network is proposing a new model for adoption by the CCGs to improve neurological services within Thames Valley, improve patient experience and reduce overall costs to the system.

Aims and objectives

The aim is to empower patients and GPs such that common neurological problems are expertly self-managed. The model will focus on developing an integrated neurology healthcare pathway (applicable to all common neurological presentations) and currently being developed for headaches; the new pathway would involve explicitly directing patients down one of several routes based on clinical criteria and good clinical judgement with the use of a clinical decision support tool.

Patient Pathways

Emergency e.g. thunderclap headache, meningitis

GP managed – majority of patients aided with by clinical decision support tool.

Urgent – all patients with red-flag symptoms are seen by General Neurologists running “Hot Clinics” within 2 weeks

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